thailand news aids 2007

THAI NEWS AIDS 2007

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Religious beliefs hamper fight against Aids: Southern Muslims must accept the fact - December 2, 2007

Religious beliefs have hindered the fight against HIV/Aids in the southern region, according to a recent study. The study says beliefs against condom use and little sex education make Muslim women and teenagers in this region a highly vulnerable group.

The stigma of being an Aids victim is a barrier in itself as it discourages Muslim sufferers all the more from seeking treatment.

"The condom use campaign for Aids prevention should not be promoted in Muslim communities since it is against Islamic beliefs of abstinence and faithfulness to one's marriage partner," said Amporn Marddent, an academic of the Walailuck University's Cultural Studies Programme School of Liberal Arts.

The research also shows that running Aids prevention and treatment campaigns in Muslim communities was a tough challenge for both the government and non-governmental organisations as most Thai Muslims still believe that only those having casual sex, and men having sex with men, could be at risk of HIV/Aids and that Muslims who strictly follow Islamic teachings had only a slim chance of contracting the virus.

Muslim women mostly contract the virus from their drug-addicted husbands.

There was also a higher infection risk among babies as most Muslim mothers gave birth at home and could not receive the necessary medication to prevent the transmission of HIV/Aids from mother to child, said Lawan Sarovat, deputy medical coordinator of Doctors Without Borders Thailand.

Of the total 13,936 new cases found in Thailand this year, 36% were housewives and female teenagers, followed by homosexual men at 24%, according to the latest report of the Public Health Ministry.

"It is evident that sex and intravenous drug use are still major problems contributing to the spread of Aids in Muslim communities," said Jirachote Sajjakul, coordinator of the Aids prevention campaign in southern provinces run by the Association of Thai Muslim Youth. "We have to accept this fact and seek appropriate solutions to deal with it."

Heroin, kratom leaves (Mitragyna Speciosa), ecstasy and codeine, a controlled substance made from opium used in cough mixtures, were also widely abused by young people in the South and more or less contributed to the spread of the virus.

Muslim men contract the virus from using injecting drugs during their teenage years and pass on the virus to their wives after marriage, Mr Jirachote said.

A survey in the three southernmost provinces by the Bureau of Epidemiology also showed that married couples were the most vulnerable group.

Schools in Muslim communities are downplaying the Aids threat by treating it as a taboo topic.

The national report also shows that as many as 77% of Thai teenagers had little knowledge of the disease, reflecting why about half of the 321,650 cases in the country were now between 25 and 34 years of age. Over half a million Thais are still living with HIV/Aids.

To solve Aids problems in Muslim communities, Mr Jirachote believes it was important for the government to come up with different projects for raising Aids awareness in the South.

Provincial Islamic committees in the South are considering whether mandatory pre-marital Aids tests are feasible. Such a practice is already in place in Malaysia's Johor state since 2001. The test results will go to the religious authorities.

If medically fit, the couple is allowed to get married. But otherwise, it is left to them to decide whether they should go ahead with the wedding and are not prevented from doing so.

Blindness in Aids patients not being diagnosed: MSF says drugs are too expensive - December 2, 2007

Blindness in HIV/Aids patients in Thailand, Burma and Cambodia is linked to a failure to diagnose and treat cytomegalovirus retinitis (CMV), according to a recent study published in the journal PLoS Medicine yesterday. The Doctors Without Borders (MSF) have studied CMV retinitis, which has been dramatically reduced in wealthy countries since the advent of antiretroviral therapy, but still found in many patients with advanced Aids in Cambodia, Burma and Thailand with 23%, 27% and 32% of the total cases respectively.

"We can diagnose CMV retinitis fairly easily and reliably in less than two minutes, and there is an effective, practical treatment, if at least the CMV retinitis is mentioned in the current and pending WHO guidelines for HIV treatment in resource-poor settings, and if Roche kindly reduce more the price for the package," said one of the authors, Dr David Wilson, a former MSF medical coordinator in Thailand.

The study, which is based on the clinical experience of Medecins Sans Frontieres and other programmes assessed by Dr David Heiden, a consultant from the SEVA Foundation in San Francisco, said detecting and treating CMV retinitis early enough would stop the slow but relentless progress of a disease that leads to blindness within three to six months in patients whose immune systems are severely weakened.

But because there are often no symptoms in the early stages of the disease, CMV can only be diagnosed through the systematic screening of all at-risk patients.

Routine retinal examination of high-risk HIV patients in Burma helped save patients from CMV-related blindness, Dr Kalpana Sabapathy, an MSF HIV/Aids adviser, said. But in many countries the best treatment option is oral valganciclovir, which costs more than US$10,000 (about 308,000 baht) for a four-month treatment course, too much for people in developing countries.

"Until then, CMV retinitis will continue to be the neglected disease of the Aids epidemic," said Dr Tido von Schoen-Angerer, the director of MSF's Campaign for Access to Essential Medicines.

In Thailand, MSF and its local partners have decided to use the sub-optimal intravenous formulation of ganciclovir as well as intraocular injections.

Oxfam: Pharmaceutical industry is undermining its own future - December 1, 2007

By keeping the traditional way of doing business that denies access to medicines to millions of poor people in developing countries, the pharmaceutical industry is undermining its own future, Oxfam says in its report.

The report, "Investing for Life", looks at the world's top 12 pharmaceutical companies, including their drug pricing policies, their record in developing medicines relevant to poor countries and their stance on protecting intellectual property rights.

Oxfam says the industry is failing to ensure universal access to medicines because it refuses to put the issue at the heart of its business model. As a result, it is failing to capture the full potential of emerging markets touted as the "new frontier" for its business success.

According to a major consultancy firm, loss of faith in the industry on the part of its investors has so far cost pharmaceutical shareholders $1 trillion.

"The industry is burying its head in the sand. More than 85% of the world's consumers are under-served or have no access to its medicines. The industry must recognise that charging high prices, quashing generic competition, developing medicines only for those rich enough to pay and fighting for harsher patent laws is an ineffective business strategy for new markets, as much as it is a moral outrage," said Jeremy Hobbs, Oxfam International executive director.

"Investors are worried about the industry's performance. They know that emerging markets are key for the industry's future growth, but companies have been responding to the challenge of breaking into emerging markets in an ad hoc and inconsistent way. This is bad for the industry and bad for poor people who are still facing devastating diseases like malaria, tuberculosis, asthma, cancer and HIV/Aids without affordable medicines,' Mr Hobbs said.

The report reveals shortcomings where the industry has failed to implement a systematic and transparent tiered-pricing policy, where prices for all essential medicines are set according to people's ability to pay.

More importantly, the investors continue largely to neglect research and development into diseases that predominantly affect poor people in developing countries.

They remain inflexible in protecting intellectual property, including challenging poor countries in court to stop them using legal public health safeguards. In addition, the investors continue to rely too heavily on donations to get affordable medicines to people, even though this is unsustainable and sometimes counter-productive.

Oxfam notes that some companies are offering differentiated prices but this is extremely limited and mainly for high-profile diseases such as HIV and Aids.

However, these offers are not systematic worldwide and are often still priced well above the means of people living in developing countries. Oxfam says that drug companies often adapt pricing in developing countries solely as a reflection of the publicity that surrounds the disease.

In Thailand, the industry failed to introduce pricing policies for key first and second line antiretroviral medicines that would enable sustainable treatment.

"The industry is operating in a short-sighted way because it could gain enormous benefits from emerging markets, including lower research and development costs and cheaper manufacturing. Yet instead it continues to blindly use its same strategies in poor countries. Even today, the richest 15% of the world consumes more than 90% of its pharmaceuticals. At this rate, both the industry and millions of sick patients are losing out," he concluded.

Teens have sex younger, but no condom: Ministry: Rate of Aids infection falls by 90% - November 30, 2007

Young people are having sex younger but fewer than half use condoms, according to a report by the Public Health Ministry.

The ministry surveyed the sexual behaviour of youths last year and found fewer than half who admitted they had casual sex said they used condoms.

The average age of youths who had sex for the first time was 15, according to the survey, a drop from 18 in previous studies. About 36% of the males and 28% of the females in the surveyed group said they had sexual experience.

The findings have been released to coincide with World Aids Day today.

The World Health Organisation's (WHO) motto to raise awareness about Aids prevention this year is "Stop Aids. Keep the Promise".

The figures from the ministry highlight concerns about the continued spread of sexually transmitted diseases, as well as the increasing numbers of unwanted pregnancies and school dropouts.

The ministry said only 23% of male teens and 26% of female teens had been educated about Aids.

Dr Somchai Pinyopornpanit, deputy director-general of communicable disease control, said some teenagers had sex to win acceptance from their peers. Many were under the impression that HIV/Aids only infects commercial sex workers.

Dr Somchai was speaking after the opening of the ministry's anti-Aids campaign yesterday at Wachira Benjathat park in Bangkok.

He said many teenagers thought it was safe to have sex with friends or someone they knew personally, so they did not feel the need to use condoms.

Patchara Siriwongrangsan, director of the office for the prevention of Aids, tuberculosis and sexually transmitted diseases, said the ministry began a project to educate youths about prevention of the disease with youth leaders from 52 schools in 15 provinces last year.

The provinces under the programme include Bangkok, Trat, Kanchanaburi, Nakhon Sawan, Samut Prakan, Nonthaburi, Chiang Mai, Lampang, Surin and Udon Thani.

More than 28,000 teenagers have undergone training in Aids prevention under the project.

Dr Patchara said her office has also launched Aids prevention activities in 16 communities and set up Aids prevention clubs in 11 schools nationwide.

Dr Somchai said there were about 39.5 million Aids patients in the world last year.

About 2.9 million died.

This year the WHO estimates there will be about 4.2 million new infections.

In Thailand, the number of new Aids infections this year is expected to be well down, from 140,000 cases in 2004 to 14,000, he said.

Of the 14,000 new HIV carriers this year, the largest single group, or 45%, is female teenagers and married women. About 20% are homosexuals, he said.

Prior to this year the Public Health Ministry estimates about one million Thais had contracted the Aids virus. More than 558,000 of them had died, he said.

Saving children from infectious diseases - November 15, 2007

From today till Saturday, leaders in the fields of pediatrics, immunology and general medicine are gathering in Bangkok for the 5th World Congress of the World Society for Pediatric Infectious Diseases (WSPID), to explore how scientific innovation can improve the lives of people across the globe. Here, some of the world's greatest medical minds will contemplate two vastly different scenarios facing the world in regard to stopping infectious diseases in children.

For the haves, the situation is stable. Affluent, industrialised nations enjoy access to life-saving vaccinations. In countries like the United States, France and Spain, inoculations have become routine, with new vaccines quickly made available to protect the most vulnerable - our children. For the have-nots, the situation is dire. Without dramatic action on a global scale to expand access to existing vaccines and accelerate the development of new ones, leading childhood killers will continue to take lives.

The most common of these killers is pneumococcal disease, which causes pneumonia, meningitis and sepsis, and claims the lives of 1.6 million people annually, half of whom are children under the age of five.

Sadly, children with HIV/Aids are up to 40 times more likely to get pneumococcal disease, and in Thailand where rates of HIV/Aids are high, pneumococcal disease places an additional burden on the national health system.

History with new vaccines shows us that we face two major challenges. First, we must encourage the development of vaccines that are needed in developing countries. Second, we must make sure that once developed, these vaccines are scaled up and rolled out to the children who need them the most. In the past, it often took 15-20 years for life-saving vaccines to reach even 20% of the children in the world's poorest countries.

Traditionally, the challenge has been ensuring that vaccines are developed to meet the needs of poorer nations and are accessible for those who are least able to pay. Today, new funding mechanisms and partnerships are working to overcome these obstacles. By investing directly in the development of vaccines, governments and philanthropies are assuring that researchers discover new vaccines against old scourges like TB and malaria. Similarly, by providing funding to assure there will be a credible market for these vaccines in poor countries, these same donors enable developing countries to access these vaccines earlier and at more affordable prices. These funding advances have created a tremendous opportunity to save lives, and the time for action is now.

This is precisely the charge of the Pneumococcal Awareness Council of Experts (PACE), an international working group of 15 of the world's leading experts in infectious disease and vaccines chartered to raise awareness of pneumococcal disease and advocate for its prevention. PACE is leading the call for increased cooperation among physicians, lawmakers, heads of state and drug makers to create vaccines and distribute them to the neediest nations.

Drug makers and governments have to join forces to find market-based solutions for market-based problems that have hindered vaccine production. The general public must make vaccine creation and distribution a top-priority item on the world's health improvement agenda, and remind our world leaders that the price of inaction is counted in lives lost needlessly to preventable diseases.

The above article has been co-authored by Dr Somsek Lolekha, President of the Medical Council of Thailand; Dr Ron Dagan, PACE Council Member and Professor, Pediatric Infectious Diseases Unit, Soroka Medical Centre and President of WSPID; and Dr Ciro A de Quadros, PACE Co-Chair and Executive Vice-President, Sabin Vaccine Institute.

Protest called over changes to drug law - November 12, 2007

The Government Pharmaceutical Organisation's (GPO) labour union and consumer rights groups will rally at the Public Health Ministry today to protest against the government's planned abolition of the state drug firm's right to stockpile necessary drugs for public use.

The demonstration is backed by local and international labour and health advocacy groups, including the Rural Doctors' Club and the International Federation of Chemical, Energy, Mine and General Workers' Unions (ICEM).

The ICEM circulated a worldwide statement yesterday supporting the GPO labour union and Thai civil groups' demands for the dismissal of the draft decree that will halt the GPO's special status for securing drugs for public and emergency uses.

The draft decree was approved by the government last month and is now being scrutinised by the Council of State.

"We believe that removing the government as a provider of essential health needs, in any form, is a recipe for higher costs, with a bigger portion of the population going without adequate health care," ICEM general-secretary Manfred Warda said in his statement.

Rawai Pupaga, the GPO's labour union president, said the government procurement of pharmaceuticals is first and foremost for the benefit of needy citizens.

"It is not an urgent matter to change the procurement procedure now. There should be a public hearing so that other stakeholders can air their views," said Mr Rawai.

Vichai Chokewiwat, the GPO board chairman, said the board shared the union's views and added that any decisions on streamlining the government procurement process should be thoroughly considered and not rushed.

Dr Vichai said the decree, if enforced in its current form, would adversely affect the government's compulsory licensing scheme, which aims to enable the GPO to procure life-saving drugs for killer diseases such as Aids and cancer at affordable prices.

Life insurer has a responsibility - November 7, 2007

American International Assurance, a subsidiary of global insurance giant AIG, must come forward and clearly explain its policies towards homosexuals. So far, executives have walked a fine line between claiming that the company does not discriminate against homosexuals while saying that a person's "lifestyle" could affect whether they get coverage.

This is not good enough. AIA has a responsibility to do all it can to avoid discrimination, and must state explicitly why certain individuals are denied coverage or forced to pay higher premiums. If the company claims all homosexuals have "lifestyles" that make them riskier clients, then executives must explain exactly what they are talking about.

If it claims, for instance, that homosexuals are more promiscuous than straight people and thus more susceptible to terminal illnesses like Aids - which is certainly the implication when executives start linking homosexuality to "lifestyle" issues - then they must base this on some legitimate fact-based research. Studies show that gay men in Thailand are in fact not the highest risk group when it comes to new HIV infections. In what may come as a surprise to some, housewives are twice as likely to become infected in Thailand, according to a 2005 report by the Disease Control Department. The DCD report found that about 40% of new infections were married women who caught HIV from their husbands, while 22% were from men who had sex with men. Another 10% were married men who contracted HIV from their wives.

Last month, Deputy Public Health Minister Vallop Thaineua said the number of new HIV infections in young women and housewives would likely rise to 45% of the country's total new infections this year, while the number of new infections among men who have sex with men was expected to drop to 20%. It is a bit surprising that AIA still leaves itself open to allegations of discrimination since the debate about whether an insurance company can deny someone coverage based on sexual orientation ended in the United States two decades ago. In late 1986, the National Association of Insurance Commissioners came up with a policy stating: "Sexual orientation may not be used in the underwriting process or in the determination of insurability."

The debate turned to focus on whether insurance companies could take blood tests before deciding whether to cover a homosexual. But here in Thailand it is unclear if AIA even lets homosexual applicants get to that stage. Thailand's largest life insurer certainly denied coverage to the wrong man when it rejected the application of long-time gay rights advocate Natee Theerarojnapong, president of the Gay Political Group of Thailand. In June, when the Constitution Drafting Assembly agreed to recognise the rights of gays and lesbians by stating in Article 30 that differences in "sexual identity" could not be grounds for discrimination, Mr Natee wept. "This is what we have fought for for decades," he said.

Mr Natee is not the first gay person to accuse AIA of discrimination. In 2001, Somsak Chalachon, owner of Chalachon Hair Studio, alleged that AIA denied him coverage even after he passed a medical exam simply because he was gay. AIA responded by saying it could not disclose "personal client information" (even to the client, apparently) and said it denied coverage for "high-risk lifestyles". Although that case faded away, Mr Natee is taking his case to the Administrative Court in one of the first major tests of the new constitution. This may force AIA and other life insurers to become more transparent in their policies towards homosexuals.

While Thailand is generally much more open to homosexuals than other countries, individual cases of discrimination still exist - including the incident earlier this year when Novotel barred a transvestite from entering its nightclub. For all the progress that's been made over the years, homosexuals and transvestites still face social stigma. Each time a company like AIA, Novotel or any other takes a clear stand against discrimination of any kind, society as a whole will benefit.

Gays accuse AIA of discrimination: Company says it protects against 'risk' - November 6, 2007

Gay activists have launched a protest against American International Assurance for unfair discrimination based on sexual preference.

AIA executives said the company had no explicit policies against homosexual clients, but reserved the right to consider applications based on risk factors related to "personal lifestyle".

Natee Teerarojjanapong, the president of the Gay Political Group of Thailand, said his application to purchase life insurance from AIA, the country's largest insurer, had been rejected solely because of his sexual orientation.

He said this was a clear violation of Section 30 of the 2007 constitution, which outlaws discrimination on the basis of race, language, sex or health.

Mr Natee yesterday submitted a complaint to the Insurance Commission and vowed to file a petition to the Administrative Court if he did not receive a response within the next couple of weeks.

He also called on the office to investigate whether other insurers also adopted such practices, and planned to co-ordinate with gay-rights advocates such as the Bangkok Rainbow Organisation to launch a global campaign against AIA.

"We condemn AIA's policy in Thailand for unfair discrimination. If AIA executives deny such practices, I will be happy to bring hundreds of homosexuals to the company to apply for insurance," Mr Natee said.

He claimed that on Oct 28, he applied for a life insurance policy with AIA agent Pachara Pipatwong, who later informed him that the company had a policy to deny insurance to gays and transsexuals.

Mr Natee added that he previously held life insurance policies with both Muang Thai and ING and that neither had ever asked about his sexual orientation.

AIA senior vice-president Sutti Rajitrangson denied that the company had any explicit policy against homosexuals. AIA was open to all applications without discrimination against any particular group of persons, he said.

But AIA reserved the right to evaluate policy coverage, premiums and set other conditions for clients in high-risk jobs or with high-risk lifestyles.

"Life insurance is a risk-management tool for the public. Underwriting criteria is thus based on risks met by the general population," Mr Sutti said.

"Anyone found to have higher risk than the general population could face higher premiums, limits in protection, restrictions on riders or even denials of their applications."

Mr Sutti added in a statement that the company's applications were judged based on various factors, including sex, age, occupation, health history and lifestyle.

"Out of our 5.8 million policyholders, we have persons belonging to high-risk groups as well. These policies were written based on our evaluation procedures and criteria," he said.

Insurance insiders say it is not unusual that companies would take steps to limit their potential liability for high-risk groups, such as smokers or persons with past drug addictions.

One AIA agent said customers are asked to fill out questionnaires to help the company assess potential health risks.

The Aids epidemic in Thailand is certainly one major public health threat faced by insurers.

Many firms require Aids tests prior to offering coverage, particularly for persons from higher-risk jurisdictions such as in the northern provinces where Aids is a particular problem.

Generic AIDS medicine from India wins nod - October 17, 2007

The Food and Drug Administration has approved the registration of the second-line Aids drug lopinavir/ritonavir for use under the compulsory licensing policy.

FDA secretary general Siriwat Thiptaradol yesterday said the drug has passed the registration process which took more than three months to complete.

The newly-approved medicine is a generic version of Aluvia, a heat-stable form of second-line Aids drug Kaletra. Both Aluvia and Kaletra are produced by the US-based Abbot Laboratories.

The government in January announced the compulsory licensing policy to bypass patents of the original versions of the second-line Aids drugs.

However, the drugs' patent holder, Abbot Laboratories, opposed the move and offered to cut the price of Kaletra to $1,000 (32,500 baht) per patient per year on a condition that the Public Health Ministry revoke its CL policy.

The ministry rejected the offer, prompting Abbot to freeze registration of Aluvia in Thailand.

GPO board chairman Vichai Chokewiwat said the agency would soon import the first lot of lopinavir/ritonavir from India's generic drug maker Matrix Laboratories.

The amount would be enough for 8,000 HIV-positive people for the next six months.

The price quoted by the Indian drugmaker was at 24,324 baht (US$695) per person per year (2,027 baht per person per month).

Meanwhile, leading cancer drug producers Novartis, Roche Laboratories and Sanofi Aventis will meet the government's price negotiation panel, led by Dr Siriwat, tomorrow to discuss the possibility of a price reduction.

The talks would be the first between the government and the world's leading cancer drug makers after the National Health Security Office last month asked the Public Health Ministry to consider overriding the patents of four cancer drugs - imatinib, letrozole, docetaxel, and erlotinib - as their prices were considered too high.

HIV/AIDS: Study prompts concern about side effects of antiretrovirals - October 15, 2007

Metabolic abnormalities caused by side effects from antiretroviral drugs are becoming increasingly prevalent among Thais living with HIV/Aids, recent studies have found.

According to a pilot study by Ramathibodi Hospital's Faculty of Medicine, published in the Journal of the Medical Association Thailand, the long-term toxicity of antiretroviral treatment has become more recognised through a variety of metabolic abnormalities including lipodystrophy, which affects body fat, and dyslipidemia, which affects the blood.

The latest study, conducted among 56 patients at the hospital, showed a high prevalence of lipodystrophy and dyslipidemia in Thai patients undergoing antiretroviral treatment.

More than 66% of the patients that took part in the study experienced health problems such as high levels of fat in their blood, high blood pressure, abnormal fat redistribution, cardiovascular and kidney disease, diabetes, and insulin resistance.

"In the past, people living with HIV/Aids tended to suffer from diseases such as tuberculosis and hepatitis C, but now non-communicable diseases have become increasing problems among HIV-positive people dependent on anti-Aids drugs," said Wisit Prasithsirikul, a medical researcher at the Bamrasnaradura Infectious Disease Institute.

Dr Wisit also conducted a study in 2004 and found similar results.

Many patients under the institute's antiretroviral treatment programme for over five years have experienced a high rate of lipid and glucose metabolism abnormalities, which are the major risk factors of cardiovascular and kidney diseases.

The institute, which specialises in treating HIV/Aids patients and communicable diseases, provided free medical treatment for 3,000 HIV-positive patients before the National Health Security Office would include the locally produced anti-Aids drug GPO-VIR in the universal healthcare scheme.

Of the estimated 500,000 people living with HIV/Aids in Thailand, 100,000 are dependent on anti-Aids drugs.

A researcher said his team of researchers are working on a large-scale study to better understand the effects of each anti-Aids drug prescribed for HIV-positive patients under the treatment programme at the institute.

He believed it was essential to conduct clinical monitoring among HIV-positive patients depending on ARV drugs under the universal healthcare scheme in a bid to better understand their effect on the prevalence of these abnormalities.

Nutrition counselling should also be provided for HIV individuals so that they can be more aware of the effects the treatments they are taking have on their bodies and their health.

Thailand To Build Anti-AIDS, Anti-Bird Flu Drug Factory - October 11, 2007

Bangkok - Thailand will build a pharmaceutical plant that will produce drugs to fight Acquired Immune Deficiency Syndrome, avian influenza, and manufacture other emergency medicines.

India will help Thailand build the plant in 18 months and at a cost of more than $27 million.

Thailand's Public Health Minister Dr. Mongkol Na Songkhla disclosed the plan during the signing of a business and trade agreement between the Government Pharmaceutical Organization of Thailand and the Hetero Drugs Co. of India.

The GPO produces cheap medicines for emergency crisis in Thailand. Hetero Drugs is a licensed manufacturer of a generic anti-bird flu drug.

Under the same agreement, the Indian firm will help Thailand plan the anti-AIDS drug factory and design the facility according to World Health Organization standards. The WHO standard will allow Thailand to sell the anti-AIDS medicine to member countries of the organization.

The Thai plant is projected to make two billion tablets a year.

Lack of funds halts condom ad campaign - September 25, 2007

The Public Health Ministry's controversial Yued Ok Pok Thung TV ad campaign aimed at promoting condom use among teenagers will be halted after Oct 12 due to budget problems.

"We don't have the budget to continue the commercials on television. However, we will promote the condom campaign through other activities instead," said Disease Control Department chief Thawat Sundarachan.

Anupong Chitworakarn, director of the Global Fund in Thailand, insisted the "proud to carry condoms" campaign would not be cancelled completely.

But he said the project will be promoted at schools and educational institutions via other activities such as exhibitions and concerts instead when the commercial contract ends. The department receives the budget to run the TV commercial from the Global Fund.

The two versions of the advert - teenagers and adults buying condoms over the counter at a convenience store, and teenagers seeing health officials at community clinics to get condoms - have been on air for over two months. But some conservative public groups have criticised them saying they damaged Thai culture and even encouraged teenagers to be sexually active. They asked the broadcasting authorities to air the adverts after 10pm.

However, a group of 30 teenagers representing the Thai Youth Network on HIV/Aids and a network of people living with HIV/Aids defended the commercials saying they were well-intended and did not encourage teenagers to engage in sexual activity. They also disagreed with the idea of running the ads after 10pm.

Yesterday, they submitted a letter to Public Health Minister Mongkol na Songkhla to keep the commercials running.

"The ad has provided us with opportunities to communicate more with our parents on the topic of sex which should not be regarded as taboo any longer," Supawat Kiewkad, 16, from Makkasan Witthaya school, said it should be an obligation for young people to carry condoms to protect themselves and their partners from unwanted pregnancies, HIV/Aids and other sexual diseases.

Cancer drugs targeted for compulsory licensing - September 24, 2007

The National Health Security Office will ask the Public Health Ministry to consider overriding the patents of four cancer drugs to help patients under the universal health care scheme.

A panel chaired by secretary-general Sa-nguan Nittayarumphong will recommend the ministry approach the two drug companies concerned with an ultimatum - negotiate a price reduction or face compulsory licensing.

The four cancer drugs are imatinib, docetaxel, erlotinib and letrozole. They have been selected from 10 groups of expensive medications, including antibiotics and diabetes drugs.

The drugs are used to treat various types of tumours, including breast and lung cancer - a predominant cause of death in Thailand, Dr Sa-nguan said.

Several thousand cancer patients were already being treated under the universal health care scheme, formerly known as the 30-baht scheme, which covers 48 million people.

The health office wants cancer treatment to be more accessible to patients.

"We could get a low-priced version of letrozole which is 40 times cheaper than the patented drug," said Dr Sa-nguan.

Letrozole is a hormonal therapy marketed as Femara.

If the ministry agreed with the proposal, a negotiating team led by the Food and Drug Administration secretary-general would discuss prices with the drug companies.

He said the ministry should first opt for "voluntary licensing" to avoid complaints of unfair treatment from drug companies. If negotiation fails, then compulsory licensing should follow.

Earlier this year the ministry announced a compulsory licensing policy for the Aids drugs Efavirenz and Kaletra, and heart drug Plavix.

Compulsory licensing is allowed by the World Trade Organisation in case of a "national emergency". This lets the ministry bypass drug patents and import or produce generic versions of patented drugs for non-commercial purposes.

THAILAND: STDs Are Spreading Fast Among School Girls - September 21, 2007

A survey of 13,429 students in 24 Thai provinces showed that more than 50 percent of the group did not use condoms during sex, which could put them at risk of infectious diseases. Somyot Kittimunkong, head of the AIDS Cluster Division, said most vocational school girls sampled had gonococcal urethritis.

Somyot said the incidence of infections, especially among teenagers, was increasing because the government no longer launches intensive prevention campaigns, having scaled down HIV/AIDS prevention efforts over the past four years. The Public Health Ministry, for budget reasons, has also shut down STD clinics, which offered disease-prevention information to HIV patients and teens.

The clinics' work was transferred to public hospitals. However, "Most hospitals lack an expert who could counsel youths or even adults with HIV," Somyot said, "so they don't have any correct information or feel confident in using condoms."

The ministry's recent campaign to convince people to carry condoms has met with criticism. Ladda Thangsupachai, director of the Culture Ministry's Culture Surveillance Center, said the Public Health Ministry's message, if not clear, could lead to misunderstandings about what condoms are used for.

Sujittra Prongsang of the Bureau of Vocational Education Standards and Qualifications at the Education Ministry said society must understand that teen sex is not an embarrassment, and condoms work to protect them from disease if they do have sex.

Be open-minded over condom use among teens, public urged - September 19, 2007

Sex education and women's rights advocates have called for the public to be more open-minded about young people carrying condoms as it is an effective means to protect themselves and society.

The group defended the health ministry's controversial TV campaign spots Yued Ok Pok Thung (Proud to carry condoms) as being well-intended and not being about teenagers' sexual desires.

The issue was discussed at a seminar held by the Thai Health Promotion Foundation following widespread criticism of the campaign, which has been on free TV for two months.

Critics, including some NGOs and members of the public, said the TV spots, which encourage youths to carry condoms wherever they go, have damaged Thai culture and even encouraged teenagers engaging in sexual activity.

But participants at the seminar mostly agreed that sex is commonplace in today's society and it should even be a "duty" of young people to carry condoms to protect themselves and their partners from unwanted pregnancy, HIV/Aids and other sexual diseases.

Somyos Kittimankong of the Department of Disease Control said society can no longer deny that teenagers are a high-risk group for contracting HIV/Aids despite the fact that condoms are easier to buy than in the past.

He cited a study of the sexual behaviour of 13,429 Matthayom 5 (Grade 11) students in 24 provinces last year, which found that less than half the male students used condoms when they had sex for the first time, while only 43% of female students made their partners use condoms while having sex.

Places where teenagers get condoms include convenience stores, public health centres, pharmacies and condom-vending machines.

Dr Somyos said Thailand was entering the second phase of an HIV/Aids pandemic with new infections continuing to increase. More action, including condom use campaigns, was needed.

Sararee Sae-Iaw, head of the Bali Hai vocational youth group from Chon Buri, said most teenagers in her group did not feel any special desire for sex after seeing the TV spots.

"Condoms are common things, and seeing them has nothing to do with our sexual desires," said Ms Sararee.

Nathapong Suksiri, of Youth Net against HIV/Aids, said since the TV spots began teenagers felt more at ease buying condoms at convenience stores or getting them from community health centres.

"I think the spots make them feel more responsible for themselves and for society by carrying condoms," Mr Nathapong said.

Ladda Tangsuphachai, director of the Culture Watch Centre of the Culture Ministry, said she was not against the condom campaign, but felt it may be too soon for everyone to accept the idea.

"I believe no parents want their children to have sex before graduation. Besides, parents are different. Some understand the issue better, but some don't.

"Working with parents who have doctorates and those who are market vendors requires different strategies. Any educational media should be made acceptable to every group," said Ms Ladda.

Clarification about HIV vaccine trial - September 18, 2007

We thank the Bangkok Post for its interest in the Phase III HIV vaccine study being performed in Rayong and Chon Buri provinces. However, we wish to clarify several of the statements in the article "Final phase of Aids vaccine trial extended" (July 31, 2007) for your readers.

The article states: "The final phase of an Aids vaccine trial in Thailand will be extended for another two years..." Actually, the Phase III HIV vaccine trial is not being "extended"; rather, the trial is scheduled to end in the summer of 2009 as planned.

At its July 18-19 meeting, the Data and Safety Monitoring Board (DSMB) recommended to the sponsor, the US Army Surgeon-General, that the trial should continue. It made a similar recommendation at each of the six previous meetings in its role as the independent data monitoring committee.

A statement from the sponsor dated July 20, 2007 is posted.

The last DSMB meeting was special because it was an "interim analysis", the only time before the end of the trial when the data are reviewed to see whether the data collected so far have shown that the vaccine prevents HIV infection.

Only the DSMB has access to this information. It is unusual for a DSMB to stop a trial early, so the recommendation to continue the trial was expected.

The article stated that the goal of this research was to "make the vaccine 80% effective after two years of research". This statement is not correct.

The trial has two objectives: 1) to show that the vaccine reduces infection by 50% compared to placebos; and 2) to show that vaccinated persons who acquire HIV infection through risk behaviour have a reduction in the amount of virus in their blood (viral load).

The article also noted that the "latest results showed only about 50-60% effectiveness".

The DSMB does not provide information on vaccine effectiveness to any person outside its membership. The investigators and sponsor will not know the level of vaccine effectiveness until the end of the trial.

The DSMB simply recommended that the trial be continued. No additional information was provided.

A few minor points should also be mentioned. The sponsor of the trial is the US Army Surgeon-General. The US Army and National Institute of Allergy and Infectious Diseases fund the study. The Ministry of Public Health executes the trial and provides clinical infrastructure and human and technical expertise to conduct the study.

Other collaborators include Mahidol University, the Royal Thai Army, Sanofi-Pasteur, and VaxGen.

There have been many smaller clinical tests of vaccines similar to the combination used in the Phase III trial; these other trials were conducted in North America, South America, the Caribbean and Europe.

A smaller test of this exact combination was conducted in Thailand by investigators from the Royal Thai Army, Mahidol University and the US Army.

There have been only two other Phase III "efficiency" trials conducted for Aids vaccines. Both were conducted with vaccines from VaxGen, called AIDSVAX.

One of those trials was conducted on intravenous drug users in Bangkok. The article mistakenly suggests that vaccine was 50% effective; AIDSVAX alone did not prevent HIV infection.

We thank you for the opportunity to clarify the matter.

DR SUPAMIT CHUNSUTTIWAT, Deputy Director, HIV Vaccine Phase III Trial, Ministry of Public Health

THAILAND: AIDS Hospice at Thai Buddhist Temple Adds Free Clinic for Life-Extending Care - September 07, 2007

Since 1992, thousands of Thais dying with AIDS have sought hospice care at the Buddhist temple Wat Phrabatnampo-Center of Hope in Lopburi, 70 miles north of Bangkok. On Aug. 31, the temple opened a free clinic to dispense antiretroviral drugs to treat the disease, project leaders said.

The new project will extend treatment and support to keep relatively healthy people with AIDS alive, according to a statement by the temple's Dramaraksa Foundation, the Lopburi provincial government and the California-based AIDS Healthcare Foundation (AHF).

According to UN estimates, 330,000-920,000 of Thailand's 65 million people have HIV.

"The number of HIV patients has continued to rise and increase rapidly, and many people are in need of [antiretroviral] medicines and better treatment and care services," said Dr. Wichai Thaitaworn, director of the Dramaraksa Foundation. "We therefore must expand our services for HIV/AIDS patients and serve their needs more effectively."

Thailand's government provides virtually free antiretroviral treatment for most people with AIDS, but the center's new project will also cover the cost of other medicine, Wichai said. The project is expected to have one physician, a nurse, and a pharmacist.

AHF President Michael Weinstein praised Thailand's leadership in its fight against HIV/AIDS, and he said he hopes this project is the first of many AHF will work on in the country. "It is my heartfelt wish that in addition to providing quality antiretroviral treatment and care services, these centers also contribute to a greater understanding of HIV/AIDS and help reduce the stigma that many of those living with the disease have encountered," Weinstein said.

EU Scolds Thailand for Violating Patents on AIDS Drugs - September 05, 2007

In a July 10 letter to Thailand's minister of commerce, European Commissioner for Trade Peter Mandelson expressed concern about Bangkok's "approach to access to medicines," specifically Thailand's policy that drug companies must offer their medicines at no more than 5 percent above the cost of generic versions.

"This approach would be detrimental to the patent system and so to innovation and the development of new medicines," Mandelson told the minister, Krirk-krai Jirapaet.

In 2001, the World Trade Organization (WTO) stated that intellectual property rules should not hamper countries from addressing public health emergencies. Mandelson said he supports the declaration, but noted it does not "appear to justify a systematic policy to apply compulsory licenses whenever medicines exceed certain prices." He asked Thailand to enter into direct discussion with companies holding the rights to certain drugs rather than threaten to overrule the patents.

In reply, Jirapaet said both WTO rules and Thailand's 1991 Patents Act allow government agencies to use compulsory licenses without prior authorization from the patent holders. Thailand has an estimated 600,000 HIV patients and has recorded approximately 300,000 AIDS deaths.

Last November, Thailand broke a patent on efavirenz, manufactured by Merck Sharp & Dohme. In 2007, it overruled patents on Kaletra, made by Abbott.

Compulsory licenses are particularly important in ensuring that HIV/AIDS patients have access to second-line treatments in case of drug resistance. In 2006, the World Bank predicted that the Thai government's use of compulsory licenses would reduce the cost of second-line drugs by 90 percent, a savings of $3.2 billion over 20 years.

Doctors Without Borders protested Mandelson's call on Thailand, saying it "blatantly ignores basic public health safeguards" agreed upon by WTO.

Drug giant threatens Indian firm with court - September 1, 2007

Giant drug firm Sanofi-Aventis has threatened to take legal action against an India-based drug manufacturer if it supplies copycat versions of its patented heart drug Plavix to Thailand.

The move, exposed yesterday by Vichai Chokevivat, chairman of the Government Pharmaceutical Organisation (GPO) board, is seen as the latest attempt by the drug giant to obstruct Thailand's controversial compulsory licensing moves.

Dr Vichai, who chairs a committee overseeing the government's compulsory licensing policy, said a Thai agent of the Indian drug firm Emcure Pharmaceuticals recently asked the Public Health Ministry to confirm that buying clopidogrel, a generic version of Plavix, from the firm was not a violation of patent law as claimed by Sanofi-Aventis.

The pharma giant has said selling clopidogrel to Thailand is illegal since the country had not made public its decision to override the patent.

However, Dr Vichai strongly denied the allegation and insisted that the ministry had officially declared its policy on the compulsory licensing of Plavix.

"The firm's remark is groundless and it will not be able to back its legal action against the generic drug manufacturer and supplier," said Dr Vichai.

The ministry, he said, would send a letter to Emcure and the Thai agent confirming that the ministry issued compulsory licences for Plavix and Kaletra, an advanced anti-Aids drug, on Jan 25 this year, for local production or import from overseas.

The ministry last week decided to import the generic drug for patients with heart disease from Emcure Pharmaceuticals, which offers clopidogrel at 1.01 baht per tablet, against the market price of 70 baht per tablet.

Plavix, a blood thinner, is used to treat coronary artery, peripheral vascular and cerebrovascular diseases.

He said that Sanofi-Aventis' threat would not affect the procurement agreement in which a first batch of 2 million heart drug tablets will be shipped in two months.

A UN-backed project is helping HIV-positive women retain their independence through micro-credit sche - August 26, 2007

As an HIV-positive widow in Cambodia, Srim Phan had no hope. That was until she was encouraged to form a group, take a loan from a micro-credit scheme and start a sewing factory.

Her life has since changed for the better, she said.

The scheme is modelled on a critically acclaimed programme known as the Positive Partnership Project, launched in Thailand by the Population and Community Development Association (PDA).

In 2006, the United Nations Development Programme (UNDP) used the PDA as a model for a pilot project to economically empower HIV-positive women. It helps the vulnerable women secure jobs and sustain their well-being.

With US$22 million (725 million baht) from the UNDP, the Women and Wealth Project provides technical and marketing training in Cambodia, China and India. The idea is to help HIV-positive women live with dignity and economic independence.

HIV-positive women are encouraged to work together to form small business enterprises to support themselves and their families.

In principle, the programme allows HIV-positive people and family members not infected by the virus to work together. It also creates better understanding of Aids in communities and reduces the social stigma of the virus.

"In a rapidly feminising epidemic, the socio-economic independence of women is essential. It enables women to cope with the devastating impact of the epidemic on their families and livelihood. Useful skills and regular income can reduce HIV vulnerability and help positive women live with dignity and security," said Catilin Wiesen, HIV team leader at the UNDP Regional Centre in Colombo.

Gender inequality and stigma are critical problems for HIV-positive women and girls in the region. This was highlighted during the International Congress on Aids in Asia and the Pacific held recently in the Sri Lankan capital.

Most married women contract the virus from their husbands. When the breadwinners die, women have difficulty achieving economic security and finding resources to run businesses and support their children. Some are forced to turn to the sex industry to survive.

Mechai Viravaidya, chairman of PDA, said access to credit is a human right, and it is also the right of women living with HIV to be economically secure and independent.

"With economic empowerment and business skills, they can overcome the barriers associated with Aids," he said.

"As I have often said, to combat the issue of HIV, we must all think outside of the box."

Srim Phan and her group opened a garment manufacturing business in Phnom Penh called the Modern Dress Manufacturing Factory.

In Chennai, India, an HIV-positive women's network has established a conceptual design and printing business called Social Light Communications. It employs two HIV-positive women and two men as partners.

Another group of HIV-infected women in Yunnan, China has set up a factory to make candles from bee's wax.

"This project is a demonstration that we can be economically independent if given a level playing field and a little support," said Srim Phan, 27, who is the firm's manager.

She said members earn about $45 (1,500 baht) a month from the export of clothing products to Japan and the US. "It's not that much, but at least we have some money to send our kids to school."

Apart from economic security, the well-being of women living with Aids is also ensured. Members of the project's garment factories in Cambodia receive anti-retroviral drugs.

It isn't easy to gain access to new markets, but she remains optimistic the group will get support from within the industry to sustain the business.

P. Kousalya, service manager of the hand-made card printing firm in Chennai, said: "We are not looking for charity, but partnerships for empowerment. If we can access even a fraction of the market, it can make a big difference to our lives."

The card business can generate up to $125 (4,100 baht) a month for each member to support their families.

She is looking forward to breaking even and paying back money to the loan scheme. Net profits will also soon be pooled into the micro-credit programme for other HIV-positive women.

"The job makes us feel alive and gives us hope for tomorrow. It also gives us the power to survive and to live for ourselves and families," she said.

Drug licensing plan averted by donor offer: Swiss company will give drugs to Thais - August 25, 2007

The Public Health Ministry has cancelled its plan to issue a compulsory licence (CL) for the production of a leukaemia drug after the Switzerland-based manufacturer promised to donate the drug to meet the demands of all Thai patients. However, it will not go back on compulsory licensing on other drugs, despite pressure from the US and the European Union.

The government has insisted the licences will save lives and that all CL moves will be considered carefully.

Vichai Chokevivat, a public health specialist chairing a committee looking into the government's CL policy, said yesterday that Novartis International AG told Public Health Minister Mongkol Na Songkhla that it would donate imatinib, under the Glivec brand, to meet demands of patients with chronic myeloid leukaemia (CML).

Earlier, Dr Vichai said the Public Health Ministry had planned to impose CL for the drug because most CML patients could not afford the treatment.

He also met representatives of the Food and Drug Administration, the ministries of foreign affairs, labour, commerce and sciences as well as Aids activists to discuss a recent written request from the US for Thailand to stop issuing compulsory licences.

The letter, dated July 20, was submitted to Prime Minister Surayud Chulanont by US ambassador Ralph Boyce.

According to Dr Vichai, the meeting resolved that the CL policy would continue because the government has a duty to ensure people have affordable access to medicine for treatment of serious diseases.

CLs are in line with the Agreement on Trade Related Aspects of Intellectual Property Rights (Trips) and the Doha Declaration which permits flexibility on patent rights for the sake of public health regardless of trade interests, he said.

Thailand says it will implement CLs only to save people's lives and not to reap commercial benefits, Dr Vichai added, arguing that some developed nations had issued more CLs than developing ones. "The US itself has widely issued CLs," he said.

He said the government was studying a proposal by Gilead Sciences Co that offered to charge a low royalty fee for production of the tenofovir antiretroviral drug for HIV-infected people who were also narcotic drug users and had hepatitis C.

He would pass on the meeting's conclusions to the public health minister and the prime minister.

Jon Ungpakorn of the Aids Access Foundation, who attended yesterday's meeting, said the government's stance was in line with international practice and was based on morality. CLs will save patients' lives because drugs will be more widely available to them, he said.

The death rate of Aids patients has dropped by 80% in the past five years thanks to availability of non-patented drugs but they now need patented and expensive drugs to cope with refractory illnesses, Mr Jon said.

Govt buys heart drug from India: Compulsory licensing praised at UN forum - August 23, 2007

The Public Health Ministry has decided to import a generic version of the heart drug Plavix from India under compulsory licensing, a policy praised by a United Nations agency and health advocacy groups as an example for other countries to follow.

The first shipment of two million tablets of clopidogrel is expected in two months, Government Pharmaceutical Organisation (GPO) board chairman Vichai Chokvivat said yesterday.

The heart drug will be supplied by the Indian company M-cure, which entered the lowest of four bids, at 1.01 baht per tablet. The price compares with 70 baht a tablet for the patented drug available on the market.

The ministry has already issued compulsory licences for two key Aids drugs, Efavirenz and Kaletra. It has already begun importing cheaper versions of Efavirenz from India, a major source of generic drugs.

The ministry has justified breaking the patents for the drugs, held by Western pharmaceutical companies, by citing budget constraints in providing advanced medication for people living with HIV/Aids under the universal health scheme, which covers 80% of Thailand's 63-million population.

Abbott Laboratories holds the patent for Kaletra while Efavirenz is patented by MSD, and Plavix by Sanofi Aventis.

"The GPO will import the medicine and ask the firm to register with the Food and Drug Administration as soon as possible," Dr Vichai said. "We will buy two million tablets in the first order and the shipment is expected to arrive in a month or two."

The ministry would save about 138 million baht, he said.

An estimated 20.5 million tablets of Plavix are needed for heart disease patients under the universal health scheme.

Only 20% of patients currently have access to the medication.

The compulsory licensing policy was hailed yesterday by non-government organisations and a UN agency.

But it was criticised by the United States, the European Union and drug manufacturers, which accused the government of stealing intellectual property and question its spending priorities.

The Eighth International Congress on Aids in Asia and the Pacific, being held in Colombo, Sri Lanka, was told Thailand's decision to run with compulsory licensing was one of the most critical political commitments yet to combat Aids. It was a good example for other countries in Asia and the Pacific heavily affected by the epidemic to follow.

"Thailand has made a strong statement by invoking a compulsory licence for the production of second-line antiretroviral drugs.

"It's the right thing to do because we just can't provide those who need with only the first-line drugs because of the high cost," said Prasada Rao, director of the UNAids regional support team.

"I urge countries in Asia and the Pacific region to use the WTO [World Trade Organisation] flexibilities to do more and show more commitment to Aids responses," he told the more than 2,500 participants at the meeting.

The 70 member countries will address the issue in the Colombo Declaration, to be released today at the end of the five-day conference.

The Asia Pacific Network of People Living with HIV/Aids has already released a statement calling on other governments, the UN and other organisations to provide access to antiretroviral drugs, including second-line treatment and other essential medicines, via the Trade Related Aspects on Intellectual Property Rights agreement. It said these were fundamental needs.

It also supported the compulsory licensing policy implemented in Thailand and strongly opposed any free trade agreements which would jeopardise the rights of both HIV-positive people and developing countries to have access to affordable medicine.

Health and consumer groups yesterday condemned US ambassador Ralph Boyce and the European Union's trade commissioner Peter Mandelson for protesting against the decision.

The groups included the Thai Network of People Living with HIV/Aids, the Aids Access Foundation, Oxfam and Medecins Sans Frontieres. Jiraporn Limpananont, president of the Consumers Foundation, said the protest letters were an unwarranted intervention in Thailand's health policy to ensure proper access to health care and treatment.

EMPOWERING THE VULNERABLE - August 2007

A UN-backed project is helping HIV-positive women retain their independence through micro-credit schemes.

As an HIV-positive widow in Cambodia, Srim Phan had no hope.

That was until she was encouraged to form a group, take a loan from a micro-credit scheme and start a sewing factory.